Temporary abdominal closure for trauma and intra-abdominal sepsis

Objective. Laparostomy can be applied in trauma, abdominal sepsis, intra-abdominal hypertension, or compartment syndrome. Systemic infections, especially if complicated by Candida, are associated with a high risk of mortality. Methods. This is a single-centre retrospective case series of 47 cases admitted to our Department, which required laparostomy procedure; we analyzed the type of surgery, temporary abdominal closure, duration of open abdomen, complications, SOFA score, mortality with Candida infections, and empirical or targeted antifungal therapy. Results. We found that patients with Candida infection were related with a statistically significant difference (p<0.05) with a complication after OA closure, total complications, time elapsed after OA application, time spent on the first surgical OA application, type of temporary abdominal closure that is used, and duration of the open abdomen. The use of empirical and targeted antifungal therapy is related to the duration of open abdomen too. Conclusions. Management of the OA is often burdened by sepsis or septic shock, especially when complicated by Candida infection. Candida score is a validated tool to identify patients who can be treated empirically, but every situation must be considered on an individual basis.

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Use of the “Bogota Bag” for Temporary Abdominal Closure in Patients with Secondary Peritonitis

The American Surgeon ◽

10.1177/000313480707300310 ◽

2007 ◽

Vol 73 (3) ◽

pp. 249-252 ◽

Cited By ~ 10

Author(s):

Boris Kirshtein ◽

Aviel Roy-Shapira ◽

Leonid Lantsberg ◽

Solly Mizrahi

Keyword(s):

Abdominal Sepsis ◽

Secondary Peritonitis ◽

Fistula Formation ◽

Temporary Abdominal Closure ◽

Abdominal Closure ◽

Flap Repair ◽

Abdominal Operations ◽

Secondary Closure ◽

Postoperative Problems ◽

Temporary Closure

Various methods may be used for temporary closure of the abdomen. Use of the “Bogota bag” (BB) technique for abdominal closure has been reported primarily in the management of injuries. This review describes our experience using the BB technique in cases of secondary peritonitis. Abdomenal closure using BB was reviewed retrospectively in 152 patients with secondary peritonitis. Of the 152 cases of BB use reviewed, 79 patients had complications of previous abdominal operations, 57 had secondary peritonitis, 14 had complications of abdominal trauma, and 2 were cases of mesenteric events. The BB remained in situ from 1 to 19 days. Changes occurred between 1 and 11 times per patient (mean, 2.8). In nine patients, early diagnosis of leaking of small bowel content under the bag was noted, and 36 patients (24%) died from sepsis. In 12 patients, the resolution of abdominal sepsis permitted secondary closure 10 days later. In 16 patients, mesh repair was performed after 4 weeks. Musculocutaneal flap repair was used in one case, and 13 patients had skin grafts. Eleven patients eventually underwent ventral hernia repair. Early temporary closure of the abdominal wall using BB in patients with abdominal sepsis and planned re-explorations is simple, safe, inexpensive, and effective. This temporary abdominal cover provides good exposure of abdominal content between re-explorations and may prevent fistula formation. The development and subsequent repair of large hernias constitute one of the difficult postoperative problems requiring future solution.

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Cost evaluation of temporary abdominal closure methods in abdominal sepsis patients successfully treated with an open abdomen. Should we take temporary abdominal closure methods at face value? Health economic evaluation

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2020.06.007 ◽

2020 ◽

Vol 56 ◽

pp. 11-16

Author(s):

Alfredo Sanchez Betancourt ◽

Gonzalez Cole Milagros ◽

Pablo Sibaja ◽

Luis Fernandez ◽

Scott Norwood

Keyword(s):

Health Economic ◽

Economic Evaluation ◽

Open Abdomen ◽

Health Economic Evaluation ◽

Abdominal Sepsis ◽

Cost Evaluation ◽

Temporary Abdominal Closure ◽

Abdominal Closure

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Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015001005 ◽

2015 ◽

Vol 42 (1) ◽

pp. 18-24 ◽

Cited By ~ 7

Author(s):

Edivaldo Massazo Utiyama ◽

Adriano Ribeiro Meyer Pflug ◽

Sérgio Henrique Bastos Damous ◽

Adilson Costa Rodrigues-Jr ◽

Edna Frasson de Souza Montero ◽

...

Keyword(s):

Wound Care ◽

Necrotizing Pancreatitis ◽

Vascular Occlusion ◽

Abdominal Sepsis ◽

Temporary Abdominal Closure ◽

Abdominal Closure ◽

Nylon Mesh ◽

Abdominal Disease ◽

The Mean ◽

Planned Reoperation

OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

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Temporary Abdominal Closure After Abdominal Aortic Aneurysm Repair: A Systematic Review of Contemporary Observational Studies

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2015.10.014 ◽

2016 ◽

Vol 51 (3) ◽

pp. 371-378 ◽

Cited By ~ 13

Author(s):

S. Acosta ◽

A. Wanhainen ◽

M. Björck

Keyword(s):

Systematic Review ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Observational Studies ◽

Abdominal Aortic Aneurysm Repair ◽

Temporary Abdominal Closure ◽

Abdominal Closure ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Temporary Abdominal Closure

Hernia Surgery ◽

10.1007/978-3-319-27470-6_40 ◽

2016 ◽

pp. 409-420

Author(s):

William W. Hope ◽

William F. Powers

Keyword(s):

Temporary Abdominal Closure ◽

Abdominal Closure

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Intake of Temporary Abdominal Closure with Abdominal Negative-pressure Therapy in Management of Nontraumatic Abdominal Surgical Emergencies to Avoid Stoma

The American Surgeon ◽

10.1177/000313481408001115 ◽

2014 ◽

Vol 80 (11) ◽

pp. 314-316

Author(s):

Brice Malgras ◽

Pierre Pasquier ◽

Dillon J. Savard ◽

Delphine Rouquie ◽

Olivier Baton ◽

...

Keyword(s):

Negative Pressure ◽

Temporary Abdominal Closure ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Abdominal Closure ◽

Surgical Emergencies

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Abdominal Wall Reconstruction After Temporary Abdominal Closure: A Ten-Year Review

Surgical Innovation ◽

10.1177/1553350606296922 ◽

2006 ◽

Vol 13 (4) ◽

pp. 223-230 ◽

Cited By ~ 16

Author(s):

Charles S. Joels ◽

Andrew S. Vanderveer ◽

William L. Newcomb ◽

Amy E. Lincourt ◽

John L. Polhill ◽

...

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Temporary Abdominal Closure ◽

Abdominal Closure

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Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure

The American Surgeon ◽

10.1177/000313480507100309 ◽

2005 ◽

Vol 71 (3) ◽

pp. 219-224 ◽

Cited By ~ 12

Author(s):

JosÉ A. Montalvo ◽

JosÉ A. Acosta ◽

Pablo RodrÍguez ◽

Kathia Alejandro ◽

AndrÉs SÁrraga

Keyword(s):

Surgical Complications ◽

Causes Of Death ◽

Surgical Complication ◽

Damage Control ◽

Multiple Logistic Regression Analysis ◽

Hypovolemic Shock ◽

Damage Control Surgery ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Abdominal Closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.

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